RESUMEN
Objective: To analyze the Caesarean Section [CS] rate among different groups of consultants dealing with Nulliparous Term Singleton pregnancy with Vertex [NTSV] presentation delivering at a tertiary care hospital of Karachi over four months
Methods: This is a secondary analysis of a retrospective data that analyzed factors affecting the CS-rate of NTSV patients. Patients with CS [n=106] were taken as cases and vaginal deliveries [n=106] as controls. This was an unmatched retrospective case-control study
Results: Mean age of patients was 26.6[SD: 4.2] years. Mean gestational-age was 38.6[SD: 1.0] weeks. Likelihood of CS was slightly less in patients who were attended by feto-maternal consultants[OR:0.81 CI:0.38-1.07] and was slightly more in patients managed by non-full-time faculty [OR:1.04 CI:0.59-1.85]. Odds of CS was highest amongst consultants having average monthly volumes of 21-30 patients/month [OR:1.069 CI:0.48-2.34]. However none of the above findings were statistically significant. A non-significant increase in risk of CS was observed with increase in experience of physicians [p=0.787]
Conclusion: The results did not show statistically significant difference in CS rate among different groups of Obstetricians. This might indicate that managing labour according to standard guidelines can eliminate physicians' bias. This can be further evaluated with larger multicenter prospective studies
RESUMEN
Objective: To compare neonatal outcomes between Category-1 and Non-Category-1 Primary Emergency Cesarean Section
Methods: This was a retrospective analysis, conducted at Aga Khan University Hospital Karachi from January 1st 2016 till December 31st 2016. Non-probability purposive sampling technique was used. A sample size of 375 patients who had primary Emergency Caesarean Section [Em-CS] was identified by keeping CS rate of 41.5% and 5% bond on error. Data was collected from labor ward, operating theatre and neonatal ward records by using structured questionnaire
Results: In the current study, out of 375 participants who underwent primary Em-CS; majority [89.3%] were booked cases. Two-hundred-eighty-two [75.2%] were primiparous women. Two hundred and thirty [61.3%] were at term and 145[38.7%] were preterm. The main indication among Category-1 CS was fetal distress [15.7%]. For Non-Category-1 CS, non-progress of labour [45.1%] was the leading cause of abdominal delivery. Except for APGAR score at one minute [p value = 0.048], no other variables were statistically significant when neonatal outcomes were compared among Category 1 and Non-Category-1 CS
Conclusion: In this study, fetal distress and non-progress of labor were the main indications for Category-1 and Non-Category-1 CS respectively. We did not find statistically significant association between indications of Em CS and neonatal outcomes. However further prospective studies are required to confirm this association
RESUMEN
Objective: To analyse the factors associated with Caesarean Section [CS] of Nulliparous, Term and Singleton pregnancies with Vertex presentation [NTSV] at a tertiary care hospital
Methods: In this unmatched retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries [SVD] were taken as cases and controls
Results: The mean maternal age of cases [CS] was 26.64 [SD:3.9] and of controls [SVD] was 26.7[SD:3.9] years, whereas mean gestational age was 38.66 +/- 1.12 and 38.57 +/- 0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed 3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant [p value 0.077]. Labour was induced in 38% patients. The Odds of Induction of Labour [IOL] were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times [81%] if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery [MOD] in this study
Conclusion: Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section